Bombs taught hospital the science of trauma care

By SUSAN TAYLOR MARTIN, Times Senior Correspondent
Published November 2, 2003

JERUSALEM - When a terrorist bomb rips through a cafe or bus, survivors don't have to wait to see a doctor at Hadassah University Medical Center.

Instead, the doctor waits for them.

As ambulances roll up, staffers are in the parking lot to assess patients and decide where best to send them - to the emergency room, to a specially equipped trauma center or directly into surgery.

"We're trying to save as many lives and prevent as many disabilities as we can," says Dr. Yoram Klein, senior trauma physician. "Another important goal is to return the ER to normal operation as quickly as possible - people don't stop having heart attacks and people are still driving like crazy. Usually two hours later we're back in business."

The speed and efficiency come from ample practice. Since the Israeli-Palestinian conflict intensified three years ago, the two Hadassah hospitals here have treated more than 2,300 survivors of terrorist attacks - almost half the number in all of Israel.

The most severely injured are taken to Hadassah University at Ein Kerem, the only Level 1 trauma center in a vast area from the Jordan River to the Mediterranean Sea. The hospital has specialists in every field - and often several are needed to treat what Klein calls the "multidimensional injuries" caused by terrorist bombings.

The primary killer is the blast effect. "The shock waves are under tremendously high pressure, like a hurricane going very fast," he says. As the force of the blast hurls the victim into a wall or onto the floor, internal organs can tear loose and rupture.

The effect is especially dangerous in confined areas like a bus. "The blast waves recoil and bounce off the walls," Klein says. "Fatalities are much higher in closed spaces."

Many bombs are also packed with nails and screws that can penetrate vital organs and cause devastating injuries. "We even had a patient that had a Calvin Klein watch go into her neck and sever the two main arteries," Klein says. (The watch was removed and she survived.)

Burns are the third major cause of death and injury. On his computer, Klein keeps a photo of a woman who was standing next to a bomber when he blew himself up. The image of the bomb belt was seared into her abdomen.

Through a hotline to the emergency room, Israel's ambulance service officially notifies the hospital of an attack and the number of casualties to expect. But staffers often are one step ahead, thanks to the ubiquitous use of mobile phones or because they heard the blast themselves. Jerusalem is a compact city, and news and sound travel quickly.

Both hospitals are owned by Hadassah, the Women's Zionist Organization of America. Founded in 1912 by an American dismayed by the poverty and sickness she saw in Jerusalem, the organization set up clinics, hospitals and medical schools.

Most were turned over to the new state of Israel in 1948, but Hadassah kept the two flagship institutions at Ein Kerem and Mount Scopus.

During Israel's 1948 War of Independence, Mount Scopus was cut off from the rest of Jerusalem, and convoys were organized to transport the medical staff safely past Arab troops. That April, a convoy was ambushed and 78 doctors and nurses killed in the worst massacre in Israeli history. The hospital closed and didn't reopen until the mid '70s.

Today, Mount Scopus is a community hospital serving both Arab and Jewish neighborhoods. About 50 percent of the patients are Palestinian.

Ein Kerem, meanwhile has become one of the leading medical and research centers in the Mideast, drawing patients even from Arab countries that don't recognize Israel.

The hospitals, which together get about $50-million a year from Hadassah, "are open to everyone," says Barbara Sofer, the organization's Israel spokeswoman. However, she acknowledged, some potential donors "don't give money because they feel we're treating the enemy."

Since the latest Palestinian uprising began, both hospitals have greatly increased security: Visitors are screened, guards carry weapons and ambulances are stopped at the entrance to make sure they are carrying real patients and not bombs or terrorists.

The uprising has also strained Ein Kerem's emergency room, designed for 40,000 admissions a year but now handling 80,000. The hospital is building a new, $40-million emergency center three times as big as the current one. It can also be sealed off to protect against unconventional warfare, including biological or chemical attacks.

With the global rise in terrorism, doctors from the United States and other countries have visited Ein Kerem to see how it handles mass casualties. Klein, who did a fellowship at Miami's Jackson Memorial, says Hadassah may develop a course especially for U.S. hospitals.

"We've gained exceptional though unfortunate experience, and right now we are more than happy to share this knowledge with what most Israelis consider their homeland, America. The sense is, you're next."